hello,
I was diagnosed with bipolar disorder five weeks ago by my neurologist. In
1996 I was diagnosed with an astrocytoma grade 2 brain tumor and had brain
surgery to remove as much as they could. Since then I've been depressed on and
off. This past year it appeared to get worse. One day I'll think about
commiting suicide or thinking about dying in a car accident. Then, I'll switch
to thinking everything is fine, then, thinking everything is great and love
living, then, back to deppression. I finaly gave in and started taking Zoloft.
It has been amazing for me so far. My obsessive thinking has gone away and feel
normal. In the past year I began thinking about my past and obsessing about
settling differences with people. On and on. I'll write an e- ail to someone
and then wonder why I sent it because I know it's not the real me who wrote it.
but, I send it anyway. Now I'm thinking about the future instead of the past and
laugh at my obsessive behaviour. I remember one time I snapped at someone at
work and was screaming at him saying all kinds of horrible things to him. When
I snapped out of it, I imediatetly had no idea what I said and had to ask
witnesses what did I say. Anyway, my question is, Is that behaviour really
bipolar or some other mental disorder? Also, my nuerologist, doctor and
pharmacist all told me that if I really need an antideppresant I will not have
any side effects. So far, I have no side effects from zoloft. And they keep
telling me that if I feel better I should not go off this medication, ever.

Dear Ms. H' --
Well, first of all, congratulations on things going so much better. I'm sure
you're among those thinking "wow, this is so much better, I don't want anybody
to change anything." At least that's what I see often in my patients
who've been through what you went through and then are no longer cycling through
those experiences. So, what might I add at this point.

Well, first of all, "was that really bipolar
disorder?" It sounds like looking back you can see that whatever it was, it
wasn't "normal" for you. Hopefully that's something more like where you're
living now. And from here, you can see that back then was just clearly
different. So, whatever we choose to call it, it was some odd
brain-chemistry/electricity deal, right? Sounds like you're wondering whether
that is some sort of effect of the brain tumor, perhaps directly, or perhaps
through some sort of seizure-like phenomenon (as that is suggested by the
"immediately had no idea what I said and had to ask witnesses what did I say"
experience, which is not at all like bipolar disorder usually looks). If your
tumor was in the region of your temporal lobe, then there is all the more reason
to think of these experiences as some sort of overlap between bipolar disorder
and a more "neurologic" basis, although I think the logic holds regardless of
where the tumor was (that's because temporal lobe seizures can appear strikingly
like bipolar symptoms).

If all you had was bipolar disorder, then the question
of whether to stick with the antidepressant for years now would be somewhat
controversial, as summarized on my page about antidepressant
controversies (in this case, #3). But because there is evidence of overlap
with another condition (e.g. the neurologic aspect; and the obsessive aspect),
you cannot directly apply those data to your situation; and therefore I have
nothing to add to what your doctors have told you about the antidepressant. I
hope that thus speaking out of both sides of my mouth came out clearly: while
there are data to suggest that staying on the antidepressant may not be the best
approach in people with bipolar disorder, your case is different, more complex,
and so I defer to your doctors there.